Journal of Sleep Disorders: Treatment and CareISSN: 2325-9639

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Research Article, J Sleep Disor Treat Care Vol: 2 Issue: 2

Different Cerebellar Responding to Acupuncture at SP6 under Different Sleep States: an fMRI Study

Dai Xi-Jian1, Liu Bi-Xia1, Min You-Jiang2, Jiang Jian1, Zeng Xian-Jun1 and Gong Hong-Han1*
1Department of Radiology, The First Affiliated Hospital, Nanchang University, Jiangxi 330006, China
2Department of acupuncture, Affiliated Hospital of Jiangxi College of Traditional Chinese Medicine, Jiang Xi 330006, China
Corresponding author : Gong Hong-Han
Department of Radiology, The First Affiliated Hospital, Nanchang University, Jiangxi 330006, China
Tel: +86-0791-8692582
E-mail: [email protected]
Received: June 13, 2013 Accepted: July 09, 2013 Published: July 11, 2013
Citation: Xi-Jian D, Bi-Xia L, You-Jiang M, Jian J, Xian-Jun Z, et al. (2013) Different Cerebellar Responding to Acupuncture at SP6 under Different Sleep States: an fMRI Study. J Sleep Disor: Treat Care 2:2. doi:10.4172/2325-9639.1000112

 

Abstract

Different Cerebellar Responding to Acupuncture at SP6 under Different Sleep States: an fMRI Study

Objective: To observe the activated differences of cerebellar stimulation before and after the sleep deprivation(SD) by acupuncturing SanYinJiao (SP6) in functional magnetic resonance imaging (fMRI) for the first time. Methods: A group of 16 volunteers each accepted acupuncture at SP6 during normal sleep (SP6 group;SG) or after 24h SD (SD-SP6 group; SSG),the interval was two weeks, meanwhile, accomplishing the brain fMRI scanning by 3.0T (Siemens;German) MR, SPM5 software was used to perform one-sample T-test and two-pair T-test,voxels with a P value<0.001, cluster size (K) ≥ 10 in one-sample T-test and P<0.005, K ≥ 10 in two-pair T-test were used to determine statistical significance. Results: SSG widely activated the cerebellum mainly located in the bilateral inferior semi-lunar lobulecerebellum posterior lobe right cerebellum anterior lobe in the condition of Sleep deprivation (P<0.001, K ≥ 10); SG only activated left cerebellum posterior lobe (P<0.001, K ≥ 10); SSG only activated right cerebellum posterior lobe (P<0.01, K ≥ 10) versus SG; The two ground all weren’t caused negative activation in the cerebellum. Conclusions: The cerebellum were all activated but the responsive regions existed difference when stimulating SP6 under both sleep states; Cerebellum posterior lobe, the common regions actived in both groups, might be a common nerve pathway of SP6 under different states and participated in processing the acupuncture information.

Keywords:

Keywords

Functional magnetic resonance imaging; SP6; Acupuncture; Cerebellum; Sleep deprivation

Introduction

We each nearly spent a third time of our life in sleep, sleep is a necessary physical needs in human life. Sleep Deprivation (SD) is a sleep loss status and generally caused by personal or environmental reasons. At present, SD is still one of the hot and difficult subjects at home and abroad.
The role of the cerebellum in motor coordination and motor behavior has been widely accepted for many years, the notion that this area is involved in emotional processing has only recently gained popularity. Furthermore, anatomical associations between the cerebellum and other regions have been suggested as a possible mechanism by which the region can affect mood processing, however, remains unclear.
We always use drug intervention treatment SD in clinical, although medications have certain curative effect, they also bring great side-effect and lead to drug addiction, they make use restriction. Therefore, it has very important practical significance to seek positive countermeasures and reduce the bad influence by SD (e.g. improving work efficiency). In terms of traditional Chinese medicine, long time SD, as a stressor, can break the functional network of nerve-endocrine-immune, and ultimately lead to decline in overall immunity and endocrine disorders. Our previous fMRI study found that acupuncture, playing a role in ameliorating brain dysfunction, could non-invasively alter distribution of restingstate networks (RSNs) of SD subjects [1]. However, whether the cerebellum involvement in acupuncture information processing and ameliorating brain dysfunction remains unclear. In this paper, we will explore the mechanis.

Materials and Methods

Subjects
Sixteen healthy subjects (eight males, eight females), ranged in age from 21 to 25 yrs (mean: 22 yrs), were recruited for this study. All sixteen subjects met the following criteria: 1. right-handed; 2. had a good sleeping habit; 3. had a regular dietary habit and did not smoke; 4. did not consume any stimulants, alcohol, tea or coffee for at least 24 h prior to the study; 5. had no inborn or other acquired diseases; 6. had no foreign implants in the body; 7. had an IQ>100 when assessed by Raven’s Progressive Matrices; 8. not on any medications; 9. moderate body shape and weight; 10. age and education were matched between males and females; 11. cerebral regular MRI did not find any organic disease; 12. no any pain (e.g. dysmenorrhea) and did not accept acupuncture treatment recent three months. This study was approved by The Human Research Ethics Committee of Nanchang University. All participants participated voluntarily and gave their written informed consent after the study procedures and potential risks had been explained.
Design
Each of the sixteen subjects participated in the test twice, the sequence was random. One was after normal sleep (NS), every subject underwent acupuncture at right SP6 (NS acupuncture group, NS-AG) respectfully; the other following approximately 24 h of total SD, every subject underwent the same acupuncture (SD acupuncture group, SD-AG). Meanwhile, accomplishing the brain fMRI-scanning when needling. To avoid effect of acupuncture, the interval between the two scans was two weeks. The stimulating procedure followed block design during task state, that is “rest--manipulating needle--rest-- manipulating needle”, totally it took six minutes. SD was conducted in a specialized room and started from 19:00 pm and ended at 19:00 pm in the following day. During the SD session, subjects were allowed to engage in leisure activities such as watch TV, surf the internet, play cards and reading. Vigorous physical activity prior to the scans was not permitted. All subjects were informed of the purposes, methods, aesthesis of acid, swell, numb and pain after Deqi during acupuncture and the particulars that were told during the experiment, so as to reduce the effect (e.g. order effects, fear), should be paid attention to. Before the fMRI, they were asked to go to the toilet (emptying the feces and urine) and rest quietly for 30 min. The subjects should close audio-visual by wearing black blinder and sponge earplugs, and fix the head to avoid audio-visual stimulus during the fMRI scans, and they were told to relax and think nothing. Participants were told to avoid head movements and swallowing during the scans. All subjects should accomplish the assessment of Deqi after the scans.
fMRI
Images were acquired on a 3.0 T TIM Trio system (Siemens, Erlangen, Germany). The scans consisted of located images, functional image and T1 sagittal image, the parameter of functional image and T1 sagittal image were the same between resting state and task state. Functional data were collected using a T2*-weighted Gradient-Recalled Echo-Planar Imaging pulse sequence with a 2000 ms repetition time (TR), 30 ms echo time (TE), 4.0 mm thickness, 1.2 mm gap, 64×64 matrix, 90° flip angle, 29 slices were obtained with 220 mm×220 mm FOV. Finally, at the same position, 176 T1 sagittal images (TR=1730 ms, TE=3.93 ms, thickness/gap=1.0/0.5 mm, inplane resolution=256×256, FOV=256 mm×256 mm, flip angle=9°) covering the whole brain were obtained. After the scans, the subjects, according to the feeling when the needles inserted, were asked to fill in the rating De-Qi scale which was made reference to Hui et al. [2]. In this paper, the feeling project is divided into six grades: the feelings, including acid, numbness, swell, periodic limb movement disorder and so on, each term divided into insentience (01 score), mild feeling (23 scores), medium feeling (45 scores), generally strong feeling (67 scores) and extremely strong feeling (89 scores) and hard to bear (10 scores).
Acupuncture treatment
The acupuncture of all subjects were performed by a same acupuncturist. The SanYinJiao (SP6) acupoint is located 10 mm proximal to the upper border of medial malleolus, between the posterior border and facies medialis of the tibia. For assessment of the specific effects triggered by SP6 acupuncture stimulation, manual acupuncture stimulation was performed by obliquely inserting a fine silver needle 0.3 mm×40 mm to a depth of about 15 ± 2 mm with one hand at right SP6 quickly and the needle was then rotated slowly when the acupuncturist felt Deqi after cleaning the skin with alcohol and marking the acupoint, it would follow normal reinforcement and normal reduction and uniformity when rotating the needle, the range was ± 180° and frequency was 1 Hz.
Data analysis
fMRI data pre-processing: Functional data were checked by using MRIcro software (http://www. cabiatl.com/mricro/)to exclude defective data. On the basis of MATLAB2009a (Mathworks, Natick, MA, USA),the fMRI data pre-processing were performed by DPARSF V2.0 software (http://restfmri.net/forum/index.php), including DICOM form transformation, slice timing, head motion correction, spatial normalization and smoothed. The first 6 volumes of each functional time series were discarded because of instability of the initial MRI signal and adaptation of participants to the circumstance. The remaining fMRI images were corrected for the acquisition delay between slices and for the head motion. Motion time courses were obtained by estimating the values for translation (mm) and rotation (degrees) for each subject. One participant who had more than 1 mm maximum displacement in x, y, or z and 1° of angular motion during the whole fMRI scan was excluded in this study. After head-motion correction, the fMRI images were normalized to the Montreal Neurological Institute (MNI) template with a re-sampling voxel volume of 3 mm×3 mm×3 mm. The 3D-T1W images were also spatially normalized to the MNI template, and then the remaining data were smoothed using an isotropic Gaussian kernel, the FWHM was 8 mm.
Task data processing: On the basis of MATLAB2009a, the preprocessing data were conducted by statistical parametric mapping (SPM5) software. The whole brain activated figure of each subject was acquired. The one-sample T-test results were presented by Xjview and REST. The resulting statistical map was set at a combined threshold of P=0.001 and a minimum continuous cluster number of 22 (corrected for multiple comparison at voxel-level by Alphasim).

Results

All subjects didn’t find significant structure abnormalities using plain MR scan. With regard to traditional Chinese medical science, De-qi of acupuncture is the key to play a role in treatment by acupuncture, it is used as a evidence to judge meridian qi ups and downs, exact acupoint selection, curative effect and prognosis, and it is a foundation for future manipulation of acupuncture, it is also one of the most important indexes of clinical curative effect. Two subjects who had more than 1 mm maximum displacement in x, y, or z and 1° of angular motion during the whole fMRI scan and one subject whose score was greater than 8 in the assessment of De-qi were excluded in this study. The remaining data were used for future processing.
So many regions in cerebellum were activated in SD-AG, including bilaterial inferior semilunar lobule of cerebellum posterior lobe (CPL), bilaterial CPL, right cerebellum anterior lobe, other regions, i.e. left frontal lobe, left temporal lobe, left parietal lobe, left limbic lobe, right thalamus, right insular lobe, bilaterial occipital lobe P<0.001 K ≥ 10); Left CPL was only activated in cerebellum in NSAG, other regions, i.e. left frontal lobe, left temporal lobe, left parietal lobe, bilaterial occipital lobe (P<0.001, K ≥ 10). Cerebellum wasn’t negative activated in both group. Right CPL and left temporal lobe was activated in SD-AG vs. in NS-AG (P<0.005 K ≥ 10); the results see Table 1 and Figures 1-3.
Table 1: The activated regions in SD-AG,NS-AG and SD-AG vs. NS-AG.
Figure 1: The activated regions in SD-AG and NS-AG.
Figure 2: The activated regions in SD-AG.
Figure 3: The activated regions in NS-AG.

Discussion

The contralateral regions and ipsilateral regions were both actived in SD-AG and NS-AG, which demonstrated the existence of the central nervous pathway. We speculated that the conduction path was much more likely to together be composed of various nerves (e.g. the feeling of spinal nerve, vegetative nerve). Its distribution are similar to the characterized by the contralateral cross and ipsilateral control of nerve fiber.
The cerebellum was both activated in SD-AG and NS-AG, but the activated regions were significant differences which mainly reflected in that the areas were more wider, the volume was bigger and the intensity was stronger in SD-AG vs in NS-AG; Furthermore, the contralateral cerebellum was only activated in NS-AG but bilateral cerebellum were activated in SD-AG. From pure acupuncture status(NS-AG) to (SD+acupuncture) status(SD-AG), the cerebellum demonstrated a regular pattern of changes, i.e., the unilateral tendency (offside) of the brain activated cerebellum started to disappear and the activated cerebellum spread to the opposite side or to bilateral sides. We preliminary thought that the changes was associated with SD.
Cerebellum anterior lobe, part of the spinocerebellum, once damaged, that was unconspicuous in cognitive and behavioral impairment [3] received the nociceptive afferent fibers of spinal cord. However, the afferent fibers of cerebellum displayed obvious ipsilateral dominance [4,5], which was consistent with the fact that ipsilateral cerebellum anterior lobe was actived in SD-AG. However, cerebellum anterior lobe wasn’t activated in NS-AG, we preliminary thought that the activation of cerebellum anterior lobe was possibly relate to the fact that cerebellum anterior lobe received the nociceptive afferent fibers caused by SD.
The thalamus, a transfer center, sends the incoming signal of the tractus spinothalamicus and the signal of the spinoreticular tract to the more advanced central [6]. CPL, having reaction to both noxious and non-noxious stimulation, received part of the fiber from lateral and anterior spinothalamic tract at the same time [7]. So we can explain the result that CPL was activated in both group. Ipsilateral thalamus and bilateral cerebellum were activated in SDAG, we suspected that acupuncture might be involved in these signal transmission, i.e. acupuncture stimulated the advanced central to intervene in SD by accelerating fiber signal transmission.CPL was only positively activated by acupuncture at SP6 both after NS and SD, which prompted that the CPL participated in processing the acupuncture information and played a role in adjustment function. It’s consistent with previous study [8,9].
The heart was controlled by both the sympathetic and the parasympathetic nerve systems. The parasympathetic nerve is dominant when it’s in quiet state, but the sympathetic nerve is dominant when it’s in tired, excited and nervous status. The cerebellum is associated with emotional processing [10]. It also influences the cardiovascular system [11] by sending out a mesh structure of fibers that further branch out fibers separately to the vagus nerves and the sympathetic nerves. Consequently, the cerebellum can change blood pressure and heart rate. SD could lead to dysfunction of autonomic nerve, i.e. the function of sympathetic nerve was increased and the function of parasympathetic nerve was reduced [12]. It also caused the heart rate increased, atrioventricular junctional premature beat and even angiocardiopathy. The CPL has been widely used for adjusting nerve function, adjusting the start, and planning and coordinating movement. It also works together with the cerebrum to complete functions such as cognition, language, and emotion, and to initiate, plan, and coordinate movement [9,13,14]. SD may target the biological mechanisms that are responsible for the possibility, unique to mood disorders, of rapid switching between depression, euthymia, and mania [15]. It can explain the result that the cerebellum was activated more widely in SD-AG than in NS-AG. We thought that the cerebellum had a wide range of functions in nerve function adjustment. It, together with the brain, finished the rapid switching of mood caused by SD. The cerebellum was a common region of acupuncture effect through modulating physiological function by nervous system. The activated cerebellum was possibly participated in the acupuncture information processing, and thus made a emergency adjustment reaction on cardiovascular response.
In short, this study gives us an important hint, to reveal the advanced functions of the brain, we obviously can’t ignore the exploration of the cerebellum.

Acknowledgments

The authors are highly grateful to all the subjects who participated in this research. This work was supported by Jiangxi provincial support program science and technology of china (grant No.20121BBG70056), national innovation experiment program for university students of china (grant No.091040307).

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